The overall objective of this proposal is to determine the effect of the application of innovative health services technology on the productivity of a rural health service system oriented to comprehensive, ambulatory health care. The proposal is divided into three phases or sub-objectives, to be carried out in three successive years; (1) To study patient flow through the Jonathan health care system in order to determine at what points the application of communications (or other health care) technology would be most effective. (2) To apply appropriate communications (or other health care) technology at those points determined by phase one, and evaluate its impact on productivity, and (3) To determine by extending our observations outside the system what communications (and/or other health care) technology is needed to support a decentralized but aggregated health care system in developing the linkages to become part of a hierarchical system. The methodology for phase one will be to study patient trajectories through the system in order to determine where "blocks" to flow occur, the consequences of those blocks, and whether the application of communications (or other innovative) technology would relieve the "block" and hence increase productivity. Specific methodology for phases two and three must await the findings of phase one, but some possible technology strategems are discussed.